Гиалуроновая кислота в лечении остеоартрита различных локализаций. Обзор литературы

Филатова Ю.С., Соловьев И.Н. Гиалуроновая кислота в лечении остеоартрита различных локализаций. Обзор литературы. Терапевтический архив. 2022;94(8):1014–1019. DOI: 10.26442/00403660.2022.08.201790

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Filatova YuS, Soloviev IN. Hyaluronic acid in the treatment of osteoarthritis of various localization: A review. Terapevticheskii Arkhiv (Ter. Arkh.). 2022;94(8):1014–1019. DOI: 10.26442/00403660.2022.08.201790

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Аннотация

В статье обсуждаются вопросы лечения остеоартрита (ОА), распространенность которого в настоящее время достаточно высока и, по данным некоторых прогнозов, увеличится еще на 50% в ближайшие 20 лет. Авторы делают акцент на высокой коморбидности среди пациентов, страдающих ОА, и высоких сердечно-сосудистых и желудочно-кишечных рисках при частом использовании нестероидных противовоспалительных препаратов, объем потребления которых постоянно растет. При обсуждении рекомендаций по лечению пациентов с ОА уделяется внимание использованию препаратов гиалуроновой кислоты (ГК) в схеме терапии, а также дискуссии о механизмах противовоспалительного и хондропротективного действия ГК в суставе, ее влиянии на хрящ и синовиальную оболочку. Обращается внимание на то, что, несмотря на более чем 30-летний опыт эффективного использования препаратов ГК в лечении ОА, эта процедура по-прежнему является предметом споров в международных профессиональных сообществах. В статье представлены результаты метаанализов и систематических обзоров, подтверждающие эффективность использования внутрисуставного введения препаратов ГК при ОА различной локализации (коленные и тазобедренные суставы, суставы кистей). В завершении приводятся рекомендации технической экспертной группы, созданной на Международном симпозиуме по внутрисуставному лечению для определения критериев успешного введения ГК при ОА различных локализаций, а также предикторов успешности и неуспешности терапии препаратами ГК. Экспертами определены показания и противопоказания для внутрисуставного введения препаратов ГК, а также состояния, связанные с повышенным риском неудачи терапии. В заключении авторы делают выводы о важности препаратов ГК для внутрисуставного введения с целью лечения ОА, начиная с ранних его стадий, согласно рекомендациям экспертов.

Ключевые слова: остеоартрит, гиалуроновая кислота, внутрисуставное введение гиалуроновой кислоты, остеоартрит коленных суставов, остеоартрит тазобедренных суставов, остеоартрит суставов кистей

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The article discusses the treatment of osteoarthritis (OA), the prevalence of which is high, and according to some forecasts it will increase by 50% in the next 20 years. The authors emphasize the high comorbidity among patients suffering from OA and high cardiovascular and gastrointestinal risks with frequent use of NSAIDs, the volume of consumption of which is constantly increasing. Discussing recommendations for the treatment of patients with OA, the article focuses on the use of hyaluronic acid (HA) preparations in the treatment of OA. The mechanisms of anti-inflammatory and chondroprotective actions of HA in the joint, its effect on cartilage and synovial membrane are discussed. Attention is drawn to the fact that, despite more than 30 years of experience in the effective use of HA preparations in the treatment of OA, this procedure is still a subject of controversy among international professional communities. The article presents data from meta-analyses and systematic reviews confirming the effectiveness of the use of intra-articular management of HA preparations in OA of various localization (knee joints, hip joints, hand joints). In conclusion, the recommendations of the technical expert group established at the International Symposium on Intra-Articular Treatment are given to determine the criteria for the successful administration of HA in OA of various localizations, as well as predictors of success and non-success of therapy with HA drugs. The experts identified indications, contraindications for intra-articular administration of HA preparations, as well as conditions associated with an increased risk of therapy failure. In conclusion, the authors draw conclusions about the importance of using HA preparations for intra-articular administration for the treatment of OA, starting from the early stages, following the recommendations of experts.

Keywords: osteoarthritis, hyaluronic acid, intra-articular administration of hyaluronic acid, osteoarthritis of the knee joints, osteoarthritis of the hip joints, osteoarthritis of the joints of the hands

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Список литературы

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1. Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393(10182):1745-59. DOI:10.1016/S0140-6736(19)30417-9
2. Fioravanti A, Tenti S, Cheleschi S. Editorial: Year 2020: New Trends in Pharmacological Treatments for Osteoarthritis. Front Pharmacol. 2022;13:892934. DOI:10.3389/fphar.2022.892934
3. Alvarez C, Cleveland RJ, Schwartz TA, et al. Comorbid conditions and the transition among states of hip osteoarthritis and symptoms in a community-based study: a multi-state time-to-event model approach. Arthritis Res Ther. 2020;22(1):12. DOI:10.1186/s13075-020-2101-x
4. Filatova YuS, Solovyov IN. Management tactics for patients with osteoarthritis: a joint view of a rheumatologist and an orthopedic traumatologist. Meditsinskiy sovet = Medical Council. 2020;(19):89-97 (in Russian). DOI:10.21518/2079-701X-2020-19-89-97
5. Filatova YuS, Solovyov IN. Patients with osteoarthritis of the knee: management in the outpatient setting. Meditsinskiy sovet = Medical Council. 2021;(2):86-93 (in Russian). DOI:10.21518/2079-701X-2021-2-86-93
6. Leyland KM, Gates LS, Sanchez-Santos MT, et al. Knee osteoarthritis and time-to all-cause mortality in six community-based cohorts: an international meta-analysis of individual participant-level data. Aging Clin Exp Res. 2021;33(3):529-45. DOI:10.1007/s40520-020-01762-2
7. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2020;72(2):149-62. DOI:10.1002/acr.24131
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16. Cho SK, Choi S, Kim H, et al. COX-2 Inhibitor Use as an Early Treatment Option for Knee Osteoarthritis Patients in Korea: A Population-Based Cross-Sectional Study. J Korean Med Sci. 2022;37(18):e148. DOI:10.3346/jkms.2022.37.e148
17. Bothner H, Wik O. Rheology of hyaluronate. Acta Otolaryngol. 1987;104(S442):25-30. DOI:10.3109/00016488709102834
18. Wang C-T, Lin Y-T, Chiang B-L, et al. High molecular weight hyaluronic acid down-regulates the gene expression of osteoarthritis-associated cytokines and enzymes in fibroblast-like synoviocytes from patients with early osteoarthritis. Osteoarthr Cartilage. 2006;14(12):1237-47. DOI:10.1016/j.joca.2006.05.009
19. Ghosh P, Guidolin D. Potential mechanism of action of intra-articular hyaluronan therapy in osteoarthritis: are the effects molecular weight dependent? Semin Arthritis Rheum. 2002;32(1):10-37. DOI:10.1053/sarh.2002.33720
20. Yasuda T. Hyaluronan inhibits prostaglandin E2 production via CD44 in U937 human macrophages. Tohoku J Exp Med. 2010;220(3):229-35. DOI:10.1620/tjem.220.229
21. Asari A, Miyauchi S, Matsuzaka S, et al. Molecular weight – dependent effects of hyaluronate on the arthritic synovium. Arch Histol Cytol. 1998;61(2):125-35. DOI:10.1679/aohc.61.125
22. Sasaki A, Sasaki K, Konttinen YT, et al. Hyaluronate inhibits the interleukin-1beta-induced expression of matrix metalloproteinase (MMP)-1 and MMP-3 in human synovial cells. Tohoku J Exp Med. 2004;204(2):99-107. DOI:10.1620/tjem.204.99
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24. Nelson AE, Allen KD, Golightly YM, et al. A systematic review of recommendations and guidelines for the management of osteoarthritis: the chronic osteoarthritis management initiative of the U.S. bone and joint initiative. Semin Arthritis Rheum. 2014;43(6):701-12. DOI:10.1016/j.semarthrit.2013.11.012
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Авторы

Ю.С. Филатова*, И.Н. Соловьев

ФГБОУ ВО «Ярославский государственный медицинский университет» Минздрава России, Ярославль, Россия
*y.s.filatova@mail.ru

________________________________________________

Yulia S. Filatova*, Igor N. Soloviev

Yaroslavl State Medical University, Yaroslavl, Russia
*y.s.filatova@mail.ru

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